Comparative Efficacy of Oral Analgesics for Reducing Morphine Consumption After Hip Surgery

Ibuprofen may represent a safe and effective oral analgesic option following hip arthroplasty, according to a study published in JAMA.

A total of 556 patients (average age, 67 years), scheduled to undergo total hip arthroplasty were randomly assigned to receive paracetamol 1000 mg plus ibuprofen 400 mg, paracetamol 1000 mg plus matched placebo, ibuprofen 400 mg plus matched placebo, or half-strength paracetamol 500 mg plus ibuprofen 200 mg, starting 1 hour after surgery and then every 6 hours for 24 hours. Baseline, surgical, and anesthesia characteristics were similar between groups.

Median 24-hour morphine consumption was 20 mg in patients receiving paracetamol plus ibuprofen, 36 mg in those receiving paracetamol only, 26 mg in patients getting ibuprofen only, and 28 mg in patients getting half-strength paracetamol plus ibuprofen. The median difference in morphine consumption was 16 mg between the paracetamol plus ibuprofen group and the paracetamol-only group (P <.001), 8 mg between the paracetamol-alone and the half-strength paracetamol plus ibuprofen groups (P =.001), and 6 mg between the paracetamol plus ibuprofen and ibuprofen alone groups (P =.002). All other between-group differences in morphine consumption in the 24 hours after surgery were deemed nonsignificant based on the minimal clinically important difference (10 mg).

Overall, 14% of participants experienced a serious adverse event within 90 days of surgery. A total of 15% of patients who received ibuprofen only experienced serious adverse events, compared with 11% of those in the paracetamol-only group. The relative risk for experiencing a serious adverse event was estimated to be 1.44 (P =.18).

Study limitations include the short intervention period.

“Paracetamol plus ibuprofen significantly reduced morphine consumption compared with paracetamol alone in the first 24 hours after surgery. However, the combination did not result in a clinically important improvement over ibuprofen alone, suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia.”

Reference

Thybo KH, Hägi-Pederson D, Dahl JB, Wetterslev J, Nersesjan M, Jakobsen JC, et al. Effect of combination of paracetamol (acetaminophen) and ibuprofen vs either alone on patient-controlled morphine consumption in the first 24 hours after total hip arthroplasty. The PANSAID randomized clinical trial. JAMA. 2019;321(6):562-571.

This article originally appeared on Clinical Pain Advisor